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PCa Screening New Areas of Research

PCa Screening New Areas of Research. Francesco Montorsi Milan. The Malm ö Preventive Project (mPP). In 1974–1986 blood samples were obtained from a cohort of 21,277 men aged up to 50

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PCa Screening New Areas of Research

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  1. PCa ScreeningNew Areas of Research Francesco Montorsi Milan

  2. The Malmö Preventive Project (mPP) • In 1974–1986 blood samples were obtained from a cohort of 21,277 men aged up to 50 • Through 1999, 498 men were diagnosed with prostate cancer, and of these 161 had locally advanced or metastatic prostate cancers • Three controls, matched for age and date of venipuncture, were selected for each case. Conditional logistic regression was used to test associations between molecular markers and advanced cancer Ullmert D; BMC Med. 2008 Feb 15;6:6

  3. The Malmö Preventive Project (mPP) Two-thirds of the advanced cancer cases occurred in men with the top 20% of PSA levels (0.9 ng/ml or higher) Ullmert D; BMC Med. 2008 Feb 15;6:6

  4. PSA at Age 60 Predicts Prostate cancer Mortality by 85 The Malmö Preventive Project (mPP) • Men who had PSA values at or below 1.2 ng/ml at age 60 had a 0.3% risk of prostate cancer death by age 85. • The risk of dying of prostate cancer by age 85 increased to: • 1.5% in men whose PSA value was 1.5 ng/mL at age 60 (67th percentile). • 3.7% in men who had a PSA level of 2.1 ng/mL at age 60 (80th percentile). • 8.9% in men who had a PSA levelfrom 2.1 to 3.4 ng/mL at age 60(90th percentile) • 15% in men who had a PSA levelof 5.2 ng/mL at age 60 (95th percentile) • 31% in men who had a PSA levelof 15 ng/mL (at age 6099th percentile). Lilja H et al AUA Meeting, Chicago, 2009

  5. CONCLUSIONS BY DR LILJA The Malmö Preventive Project (mPP) • Sixty-year-old men with PSA at or below the population median can be advised that although they may harbor cancer, it is unlikely to become life threatening • Those with PSA elevated above thresholds such as 3 or 4 ng/mL are at greatly increased risk of clinically diagnosed prostate cancer and prostate cancer-specific death Lilja H et al AUA Meeting, Chicago, 2009

  6. Median PSA level: • men aged 40-49 was 0.7 ng/mL • men aged 50-59 was 0.9 ng/mL Loeb S. et al. Urology 2006,67:316–320

  7. Baseline PSA level was a significant predictor of CaP diagnosis Loeb S. et al. Urology 2006,67:316–320

  8. Baseline PSA in PCa patients 50-60 yo Baseline PSA in PCa patients 50-60 yo

  9. Loeb S. et al. Urology 2006,67:316–320

  10. An initial PSA cutoff of 1.5 ng/ml may be better than median PSA 0.7 ng/ml to determine the risk of PCa in men ≤50 years old Tang P et al, J Urol 2010;183,946-951

  11. Increased Risk of PCa in FU years in men with baseline PSA > or < 1.5 Tang P et al, J Urol 2010;183,946-951

  12. Examination of a greater number of data sets suggests that for men 50 to 70 years a PSA greater than 1.5 ng/ml is a marker for greater risk of PCa in the short to medium term (up to 8 years), • These men are at 7.5-times greater risk for prostate cancer than those with PSA less than 1.5 ng/ml. • For younger men with longer follow-up a lower PSA should be considered. • In addition, the PSA threshold should be lower for men with a prostate volume less than 40 cc, black ethnicity or a family history of prostate cancer. Robool et al, J Urol 2009; 182:2112-22

  13. AUA Prostate Cancer Guidelines 2009

  14. AUA Prostate Cancer Guidelines 2009

  15. “It seems reasonable to obtain a baseline PSA testing at age 40 to assess the risk for further PCa detection” NCCN Prostate Cancer Guidelines 2010

  16. CONCLUSIONS • Initial evidence is suggesting that men in their 40 - 50 years represent a population who needs to be investigated • It would be interesting to study both men with and without a family history of PCa

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